Provider Demographics
NPI:1669605044
Name:AHMED, TARIQ (SLP)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 BALI CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2801
Mailing Address - Country:US
Mailing Address - Phone:505-292-7104
Mailing Address - Fax:505-296-2183
Practice Address - Street 1:4505 BALI CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2801
Practice Address - Country:US
Practice Address - Phone:505-292-7104
Practice Address - Fax:505-296-2183
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNOT KNOWN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid